In patients with acute hereditary angioedema is Icatibant better than C1 esterase inhibitor at reducing mortality?

Report By: Katherine Palmer - Medical Student
Search checked by Katherine Palmer - Medical Student
Institution: Manchester Royal Infirmary
Date Submitted: 12th July 2010
Last Modified: 13th July 2010
Status: Blue (submitted but not checked)

Three Part Question

In [patients with acute hereditary angioedema] is [Icatibant] better than [C1 esterase inhibitor] at [reducing mortality]?

Clinical Scenario

A 45 year old female with known hereditary angioedema has a moderately serve acute attack which began 8 hours ago. Her sister died during an acute episode 1 year ago and she is very frightened herself. She has has C1 inhibitor in the past but has read about Icatibant on the internet.

Search Strategy

MEDLINE 1950 to 2010 June Week 5 and Embase 1980 to 2010 Week 27 using the OVID interface on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
MEDLINE and Embase - (exp Hereditary Angioedema Type III/ OR exp Angioedema/ OR exp "Hereditary Angioedema Types I and II"/ OR hereditary angioedema.mp. OR angioedema.mp.) AND
(exp Complement Inactivator Proteins/ OR exp Complement C1 Inactivator Proteins/ OR exp Complement C1 Inhibitor Protein/ OR c1 esterase inhibitor.mp. OR c1 inhibitor.mp.)AND (exp Receptor, Bradykinin B2/ OR Icatibant.mp. OR firazyr.mp. OR bradykinin 2 receptor antagonist.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Icatibant)

Search Outcome

MEDLINE - 18 papers, 0 relevant
Embase - 75 papers, 0 relevant
CINAHL - 7 papers, 0 relevant

Comment(s)

Icatibant is a new treatment for hereditary angioedema and is undergoing clinical trials for both acute and prophylactic therapy. There are currently no trials comparing Icatibant with the current licensed treatment of C1 inhibitor.

Clinical Bottom Line

Until further trials have been conducted treatment of acute hereditary angioedema should be with the licensed C1 inhibitor.